• Journal of Chest Surgery
• /
• 제21권4호
• /
• pp.772-777
• /
• 1988

Because of increasing myocardial damage by normothermic arrest, most of cardiac surgeons now uses many kinds of method reducing myocardial injury, such as systemic hypothermia, topical cooling and cold cardioplegic solutions. And phrenic nerve paralysis has been reported with the use of iced slush for topical cooling. So we reviewed the preoperative and postoperative chest X-rays of 54 patients undergoing open heart surgery with the use of iced slush for topical cooling to find phrenic nerve paralysis. Four of 54 patients were known to have phrenic nerve paralysis. The first time known to develop phrenic nerve paralysis was from POD 4 1 day to POD 4 3 day and the phrenic nerve paralysis resolved within a month postoperatively except one. A patient have had phrenic nerve paralysis persistently over 7 months. And the effect of unilateral phrenic nerve paralysis was of no clinical significance.

• Journal of Chest Surgery
• /
• 제51권5호
• /
• pp.363-366
• /
• 2018

One of the complications of permanent pacemaker implantation is unintended phrenic nerve stimulation. A 15-year-old boy with a permanent pacemaker presented with chest discomfort due to synchronous chest wall contraction with pacing beats. Even after reprogramming of the pacemaker, diaphragmatic stimulation persisted. Therefore, we performed thoracoscopic phrenic nerve insulation using a Gore-Tex patch to insulate the phrenic nerve from the wire. A minimally invasive approach using a thoracoscope is a feasible option for retractable phrenic nerve stimulation after pacemaker implantation.

• Journal of Chest Surgery
• /
• 제20권3호
• /
• pp.483-488
• /
• 1987

Phrenic nerve injury has been reported with the use of iced slush for topical cardiac hypothermia. A review of the preoperative and the postoperative chest roentgenograms was performed to detect phrenic nerve injury in patients undergoing cardiac operation with the use of iced slush for topical hypothermia from January, 1985 to June, 1987. The reviewed series included 45 patients who had undergone valve replacement. In this review, the injured site of phrenic nerve was left in 13 cases, right in 1 case and the overall incidence of phrenic nerve paralysis following open heart surgery was 31%. Compared to the incidence of phrenic nerve paralysis in the control group [without pericardial insulation] [406, 12 cases/30 cases], that in the group of patients receiving pericardial insulation [13.3%, 2 cases/15 cases] was lower, but there was no statistical significance. The initial time that diaphragmatic paralysis developed was mean 3.5 days [range 1-8 days] postoperatively and the recovery time of the paralysis was mean 4.7 months [range 0.5-10.5 months] postoperatively.

• The Korean Journal of Pain
• /
• 제24권2호
• /
• pp.105-107
• /
• 2011

Hiccups have more than 100 etiologies. The most common etiology has gastrointestinal origins, related mainly to gastric distention and gastroesophageal reflux disease. Intractable hiccups are rare but may present as a severe symptom of various diseases. Hiccups are mostly treated with non-invasive or pharmacological therapies. If these therapies fail, invasive methods should be used. Here, we present a patient on whom we performed a blockage of the phrenic nerve with the guidance of a nerve stimulator. The patient also had pneumothorax as a complication. Three hours after intervention, a tube thoracostomy was performed. One week later, the patient was cured and discharged from the hospital. In conclusion, a stimulator provides the benefit of localizing the phrenic nerve, which leads to diaphragmatic contractions. Patients with thin necks have more risk of pneumothorax during phrenic nerve location.

• Journal of Chest Surgery
• /
• 제35권10호
• /
• pp.730-735
• /
• 2002

횡격막은 횡격막 신경과 동측의 하 흉벽 늑간신경의 지배를 받는다. 상완신경총의 적출 손상을 가진 환자에서 신경총의 일부 신경의 신경이식술에 횡경막 신경의 신경 이식편이 종종 이용된다. 이와 같이 횡격막 신경이 신경이식편으로 사용된 환자에서 횡격막 신경의 탈신경으로 인하여 발생하는 횡격막의 위치 및 운동의 변화를 연구하였다. 대상 및 방법 : 어께의 둔상으로 상완신경총의 적출 손상 때문에 동측의 횡격막 신경으로 근피부신경에 신경이식술을 시행한 13예를 대상으로 하였다. 흉강경 수술방법으로 흉강 내 횡격막 신경을 박리하고 횡격막 바로 위에서 횡격막 신경을 절단하여 경부 절개창을 통해서 외부로 끌어낸 다음 피하 터널을 통해서 동측의 근피부신경에 이식하였다. 엑스선 투시검사와 흉부 엑스선 촬영으로 수술 전후의 횡격막 위치 및 운동 상태를 조사하였다. 결과 : 흉강경을 이용하여 횡격막 신경을 박리 절단하는데 기술적 어려움이나 경미한 합병증도 없었다. 횡격막 신경의 절단 직후에는 횡격막이 평균 1.7 늑간 정도 올라가 있었으나, 엑스선 투시검사에서 흡기시 횡격막의 역행성 운동은 보이지 않았다. 1.5개월 이후의 엑스선 검사에서 횡격막의 위치는 수술 전에 비해 유의한 차이 없을 정도(평균 0.9 늑간 차이; p＝NS로 복원되었다. 횡격막 신경의 절단으로 횡격막의 운동 범위는 탈신경 전에 비해 유의한 차이가 없었다. 결론 : 횡격막 신경의 차단으로 인한 탈신경 후 횡격막의 운동기능은 남아 있었으며 횡격막의 위치는 시간이 경과함에 따라 어느 정도 회복되는 현상을 보였다. 그러나 폐활량이 계속 감소된 소견은 횡격막의 흡기력이 완전히 회복되지 않았음을 추정할 수 있다.

• Journal of Chest Surgery
• /
• 제25권12호
• /
• pp.1542-1549
• /
• 1992

From March 1986 to August 1992, 18 patients underwent diaphragmatic plication for the diaphragmatic paralyses complicating various pediatric cardiac procedures. Age at operation ranged from 16 day to 84 months with mean age of 11.8 months. In order of decreasing incidence, the primary cardiac procedures included modified Blalock-Taussig shunt [ 5 ], Arterial switch operation [ 4 ], modified Fontan operation [ 2 ], and others [ 7 ]. The suspicious causes of phrenic nerve injury included overzealous pericardial resection [ 7 ], direct trauma during the procedure [ 6 ], dissection of fibrous adhesion around the phrenic nerve [ 3 ] and unknown etiology [ 2 ]. The involved sides of diaphragm were right in 10, left in 7 and bilateral in one. The diagnosis was suspected by the elevation of hem-idiaphragm on chest x-ray and confirmed by fluoroscopy. The interval between primary operation and plication ranged from the day of operation to 38 postoperative days [mean : 14 days]. The method of plication were "Central pleating technique" described by Schwartz in 16 and other techniques in 2. Five patients expired after plication and the cause of death were not thought to be correlated directly with the plication itself. In the remaining 13 survivors, extubation or cessation of positive ventilation could be done between the periods of the day of plication and 14th postoperative days [mean; 3.8day]. We have made the following conclusions : 1] Phrenic nerve paralyses are relatively common complication after pediatric cardiac procedures and the causes of phrenic nerve injury are mostly preventable; 2] Phrenic nerve palsy is associated with corisiderable morbidity; 3] diaphragmatic plication is safe, reliable and can be applicable in patients who are younger age and require prolonged positive pressure ventilation.ntilation.

• Journal of Chest Surgery
• /
• 제35권7호
• /
• pp.560-563
• /
• 2002

심흉부 수술 후에 발생하는 횡격막 신경 손상으로 인한 편측 횡격막 마비는 드물지 않게 발생하는 질환으로 증상 없이 방사선학적 비정상 소견만을 보이는 것에서 심한 폐기능 장애와, 심지어는 폐기능이 저하되어 있는 환자에서는 사망을 초래하기도 하는 질환이다. 이러한 증상이 발현된 편측 횡격막 마비시, 마비된 편측 횡격막의 주름성형술이 가장 효과적인 치료방법으로 알려져 있다. 본원에서는 천식의 병력이 있는 38세의 남자 환자의 전종격동에 발생한 종양 절제시 발생한 우측 횡격막 신경 손상에 대해 비복 신경을 이용한 횡격막 신경 재건술을 시행하여 술후 10개월째 시행한 단순 흉부 방사선 검사상 좋은 결과를 얻었기에 간략한 문헌 고찰과 함께 보고하는 바이다.

• Annals of Clinical Neurophysiology
• /
• 제7권1호
• /
• pp.28-30
• /
• 2005

Bilateral brachial neuritis is clinically uncommon and accidentally involvement of bilateral phrenic nerves is rarely reported. We experienced a 26 year old man who developed subacute onset of asymmetric bilateral shoulder and arm weakness. The weakness slowly aggravated and finally suffered from dyspnea due to bilateral phrenic nerve palsy. Cervical spine MRI and CSF study showed no abnormality. Viral markers and other serological test showed no specific finding. Electromyographic study showed bilateral brachial axonal polyneuropathy with cervical and upper thoracic polyradiculopathy. And bilateral phrenic nerve conduction study showed no resopnse. He showed no improvement for 10 months after treatment and managed with continuous artificial ventilation. We report a case of idiopathic bilateral brachial neuritis accidentally involving bilateral phrenic nerves.

• The Korean Journal of Pain
• /
• 제10권2호
• /
• pp.241-245
• /
• 1997

Persistent hiccup is defined as duration lasting longer than 48 hours. Reflex arc of hiccup is divided into three parts : afferent, central, efferent. Afferent portion of the neural pathway of hiccup formation is composed of vagus nerve, phrenic nerve, and sympathetic chain arising from T6 to T12. Efferent limb is phrenic nerve. Hiccup center is located in brain stem, midbrain, reticular system and hypothalamus. Persistent hiccup is very difficult to treat by conventional methods. We performed cervical epidural block of the phrenic nerve root for three patients suffering from persistent hiccup. The therapeutic effect was perfect. The mechanism of the cervical epidural block is not yet defined however it is thought to block the efferent nerve fibers and suppress the reflex arc of hiccup. We conclude cervical epidural block is relatively safe and very effective for treating persistent hiccup.

• Journal of Korean Neurosurgical Society
• /
• 제54권4호
• /
• pp.359-362
• /
• 2013

Chronic hypoventilation due to injury to the brain stem respiratory center or high cervical cord (above the C3 level) can result in dependence to prolonged mechanical ventilation with tracheostomy, frequent nosocomial pneumonia, and prolonged hospitalization. Diaphragm pacing through electrical stimulation of the phrenic nerve is an established treatment for central hypoventilation syndrome. We performed chronic phrenic nerve stimulation for diaphragm pacing with the spinal cord stimulator for pain control in a quadriplegic patient with central apnea due to complete spinal cord injury at the level of C2 from cervical epidural hematoma. After diaphragmatic pacing, the patient who was completely dependent on the mechanical ventilator could ambulate up to three hours every day without aid of mechanical ventilation during the 12 months of follow-up. Diaphragm pacing through unilateral phrenic nerve stimulation with spinal cord stimulator was feasible in an apneic patient with complete quadriplegia who was completely dependent on mechanical ventilation. Diaphragm pacing with the spinal cord stimulator is feasible and effective for the treatment of the central hypoventilation syndrome.